title: Economic evaluation of an integrated care programme for patients with hand dermatitis.
abstract: BACKGROUND
  Hand dermatitis has a large impact on society as a whole.
  
  
  OBJECTIVE
  To evaluate the cost-effectiveness of integrated, multidisciplinary care as compared with usual care (UC) for patients with moderate to severe chronic hand dermatitis after 52 weeks.
  
  
  METHODS
  Patients (n = 196) visiting the dermatology department at one of the participating hospitals for hand dermatitis were randomized to integrated care (IC) or UC. IC was provided by a multidisciplinary team, and integrated clinical and occupational care to optimize treatment of hand dermatitis. Effect outcomes were clinical assessment of hand dermatitis with the Hand Eczema Severity Index (HECSI), and disease-specific quality of life, work performance and quality-adjusted life-years with the EQ-5D. Incremental cost-effectiveness ratios (ICERs) were calculated. The ICER indicates the additional investment needed to gain one unit of effect.
  
  
  RESULTS
  The HECSI difference between both groups after 52 weeks was 8.7 (standard error 5.3, 95% confidence interval -1.8-18.9). No differences were found on secondary outcome measures. Mean total costs with IC (€ 3613; SD 798) were significantly higher than with UC (€ 1576, SD 430). The ICER for improvement in HECSI score was -247. IC was not considered to be cost-effective as compared with UC. The probability that IC was cost-effective was 90% at a ceiling ratio of € 1500 per additional point improvement in HECSI score.
  
  
  CONCLUSIONS
  Integrated care was neither cost-effective, nor effective after 12 months follow-up, in contrast to our findings after 6 months. Decision makers should decide whether the clinical benefits of integrated care on the short term outweigh the higher costs compared to usual care.
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Robin F
authors.initials: RF
authors.lastname: van Gils
authors.forename: Judith E
authors.initials: JE
authors.lastname: Bosmans
authors.forename: Cécile R L
authors.initials: CR
authors.lastname: Boot
authors.forename: Thomas
authors.initials: T
authors.lastname: Rustemeyer
authors.forename: Willem
authors.initials: W
authors.lastname: van Mechelen
authors.forename: Pieter G M
authors.initials: PG
authors.lastname: van der Valk
authors.forename: Johannes R
authors.initials: JR
authors.lastname: Anema
mesh_terms: D000328:Adult; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics*; D005260:Female; D006229:Hand Dermatoses / Q000628:therapy*; D006801:Humans; D008297:Male; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care; D011788:Quality of Life; D012720:Severity of Illness Index
keywords: atopic dermatitis; occupational; treatment